Towards the end of a pregnancy, about three to four percent of women in the UK will have a baby in breech position. This means the baby is bottom-down, with their rump presenting and their limbs going up alongside them. You and your doctor will make a plan for the delivery with special options if your baby is breech. You will be offered a procedure called an External Cephalic Version, or an ECV. This is where an obstetrician or a trained midwife or nurse encourages your baby to do a forward roll so that they go from a bottom-down to a head down position. If this is successful, you can have a vaginal birth with the baby in the more favourable cephalic (head-down) position. You can opt to have a vaginal breech baby—push out a baby that’s bottom-down—this is allowed, but it is important to have a full discussion with your doctor about the mechanisms of a breech birth, and the pros and cons. You will also need to ensure that support will be available for a breech birth at the centre or hospital where you plan to deliver.

Why is my baby breech?

It may just be a matter of chance. A breech position is very rarely a sign there is a problem with the baby, and if this were the case, it would likely be picked up at your 20-week anomaly scan. Certain factors make it more difficult for your baby to turn and therefore more likely to be breech. These can include a first pregnancy, a low-lying placenta, having too much or too little amniotic fluid, or being pregnant with more than that one baby.

What are the pros and cons of a breech birth?

The pros include having the vaginal birth you want and the same pain medication options as everyone else, though this may vary by healthcare provider. The risks include physical complications for your baby during labour, such as the head getting stuck, broken or dislocated bones, brain bleeding, or Erb’s palsy. The umbilical cord can also flatten or twist, cutting off the baby’s oxygen.

There are some situations where you will be advised not to attempt a breech birth, such as if you have pre-eclampsia, you have a low-lying placenta, your baby’s feet are below their bottom, or your baby is larger or smaller than average.

Will my baby just flip around on their own?

This can happen but is less likely the farther along in pregnancy you are. Complementary therapies like acupuncture encourage the kind of relaxation in your body, and especially your uterus, that may inspire a baby to do a somersault. Some women try special exercises to encourage the baby to roll forward.

How does an ECV happen?

An ECV is usually offered after 36 or 37 weeks of pregnancy, though it can be performed right up to early labour. ECV stands for external (because pressure comes from the outside) cephalic (meaning head down) version, which means turning. You don’t need to do anything to prepare. Before an ECV, you’ll have an ultrasound scan to confirm your baby is breech. Your pulse and blood pressure will be checked. Relaxing the muscles of your uterus has been shown to help a baby turn, so you’ll be injected with salbutamol to help this happen. This medication is safe for you and your baby, though you may feel flushed and that your heart is beating faster.

An obstetrician or specially trained midwife or nurse will perform the ECV by applying pressure to your abdomen to help move the baby into a head-down position. The ECV itself will only take about fifteen minutes. However, as the baby needs to be monitored before and afterwards, the appointment could last up to three hours.

After an ECV, the ultrasound will be repeated to ensure your baby has turned. If it has been unsuccessful or your baby returns to a breech position, you will likely be offered another ECV at a later date.

Does an ECV hurt?

Yes, it can occasionally be painful. It’s usually uncomfortable at worst, and you can ask for a break for a couple of minutes. We realise Kim Kardashian’s description of her ECV may have inspired you to research the procedure. An ECV is really just pressure on the tummy; it shouldn’t hurt that much, and it certainly shouldn’t hurt more than childbirth. We’re very sorry for her terrible experience and can assure you that it is rare.

Is an ECV safe?

An ECV is considered safe. There are circumstances in which you won’t be offered one. These include multiple pregnancies, vaginal bleeding, your waters breaking, your baby’s heart rate is abnormal, or you need to deliver by caesarean section for other reasons, such as placenta praevia.

Does an ECV always work?

ECVs are successful in about 50% of cases, according to the Royal College of Obstetricians and Gynaecologists. It is more likely to succeed if you’ve had a vaginal birth before. If it is unsuccessful, you may be offered another attempt at a different date.

If I decide to have a planned caesarean section for my breech baby’s delivery, will having an anterior placenta complicate things?

The incision the surgeon makes will typically be too low down to interfere with an anterior placenta. Rarely, a woman will have anterior placenta praevia, where the placenta is not only on the front wall of the womb but right down in the lower segment of the uterus. In such a case, it will be up to the obstetrician where they want to put the incision to get the baby out safely. Whatever incision is made, this will be done because your doctor thinks it’s the safest way to get your baby out.

What is a transverse baby?

This means your baby is in a sideways position. Your healthcare team will often put a safety plan in place rather than try to flip the baby, as there is usually a reason they’re in this position, such as a fibroid or lots of amniotic fluid around them, and they may simply move back. If a baby is predicted to be born transverse, you will usually undergo safety checks at 37-38 weeks. It could be that you need to stay in hospital until you give birth, as if your baby is sideways and your waters break or you go into labour, there’s nothing to come down first but the baby’s hand and the umbilical cord, and you will likely need special support.

For more information on what to expect in late pregnancy, watch Unii's Giving Birth Journey videos with top obstetrician Dr. Keith Duncan.

What is an ECV and will it hurt?

Unii looks at this procedure for turning breech babies and what you can expect.